Financial Counselor (AD0709 - East)

The Financial Counselor is responsible for verification of coverage and out-of-pocket amounts for patient accounts, outpatient surgeries, inpatient surgeries, and other specialty care. Generate reports as needed, communicates with multiple departments, monitors accounts for proper documentation, authorizations, insurance verifications, deposits and self-pay balances. Updates accounts and collects verification of relevant patient data.  Make payment arrangements for outstanding balances. 

DUTIES AND RESPONSIBILITIES:

1. Follows policy and procedures regarding financial screening, arrangements, and third-party demands.  Assures proper financial classification, determines proper guarantor and updates system accordingly.  Offers expert advice to clinicians and care teams on coding, billing, and other revenue matters supporting organizational goals. 

2. Point of contact for patients regarding payments and other related financial matters pertaining to hospital services and prenatal care prior to referring to Business Office.  Direct representative between Business Office and patients, staff, and providers to resolve issues when applicable.   

3. Verifies benefit coverage to include co-pays, deductibles, and co-insurance. Documents and notes to include verification, authorization, and co-pay to be collected at time of procedure. Determines co-pay, share of costs and deductible status using information obtained during verification process.

4. Facilitates contact of patients prior to service to advise of Center policy regarding co-pay and prepares installment agreement, if needed.  Makes payment plan arrangements with patients for past due balances; monitors delinquent accounts and appointments for habitual non-paying patients. 

5. Provides excellent internal/external customer service via telephone, email or face-to-face contact to assist patients with their health care needs. Communicates with clients, support staff and third-party payors to address insurance questions and concerns regarding charges, payments, adjustments, benefits, and possible refunds.  

6. Obtains necessary referrals, authorization and pre-certifications as needed.  Provides estimates for procedures to patients, physicians’ offices, and payers as requested.

7. Assist with training clinical staff members regarding insurance verification, entering of individual plans, and fields questions in the manager’s absence. 

8. Completes special projects as needed (i.e. assist with completion of special reports and problem resolution projects). 

9. Reviews daily pre-op, surgery and outpatient schedules generated to ensure account information is complete prior to services rendered.

10. Obtains patient demographic data not captured during scheduling process, which is necessary for claims processing.

11. Ensures that routine and priority tasks are completed within established departmental time frames.

12. Performs other related duties as assigned. 

JOB QUALIFICATIONS:

High school diploma or equivalent

Coding certification preferred

Minimum five (5) years’ experience in insurance verification of third-party health insurance

Knowledge of ICD and CPT codes and medical terminology

Experience in the use of personal computers, including proficiency in Microsoft Word, Excel, Outlook 

Electronic Health Record experience is required, eCW is preferred. 

Bilingual in English and Spanish preferred

Scheduled hours and/or work locations are subject to change

PHYSICAL ACTIVITIES AND REQUIREMENTS:

Finger Dexterity: Using fingers to make small movements such as typing or picking up small objects.

Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.

Hearing: Able to hear average or normal conversations and receive ordinary information.

Repetitive Motions: Frequently and regularly using the wrists, hands, and fingers.

Visual: Average, ordinary, visual acuity necessary to prepare or inspect documents or other materials.

Physical: Limited physical effort required; May have to lift folders, files, papers, audio/video equipment, and other such items weighing up to approximately 25 lbs.